The late stage of Parkinson's -results of a large multinational study on motor and non-motor complications.

INTRODUCTION: There is little information on the late stages of parkinsonism. METHODS: We conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less. RESULTS: Average disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment. CONCLUSION: These data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients.

Bisphosphonates and mortality: confounding in observational studies?

Numerous observational studies suggest that bisphosphonates reduce mortality. This study showed that bisphosphonate use is associated with lower mortality within days of treatment, although the association was not significant until the second week. Such an early association is consistent with confounding, although an early treatment effect cannot be ruled out. INTRODUCTION: The purpose of this study was to examine whether confounding explains why numerous observational studies show that bisphosphonate use is associated with lower mortality. To this end, we examined how soon after treatment initiation a lower mortality rate can be observed. We hypothesized that, due to confounding, the association would be observed immediately. METHODS: This was a retrospective cohort study of hip fracture patients discharged from Swedish hospitals between 1 July 2006 and 31 December 2015. The data covered 260,574 hip fracture patients and were obtained from the Swedish Hip Fracture Register and national registers. Of the 260,574 patients, 49,765 met all eligibility criteria and 10,178 were pair matched (bisphosphonate users to controls) using time-dependent propensity scores. The matching variables were age, sex, diagnoses, prescription medications, type of hip fracture, type of surgical procedure, known or suspected dementia, and physical functioning status. RESULTS: Over a median follow-up of 2.8 years, 2922 of the 10,178 matched patients died. The mortality rate was 7.9 deaths per 100 person-years in bisphosphonate users and 9.4 deaths in controls, which corresponded to a 15% lower mortality rate in bisphosphonate users (hazard ratio 0.85, 95% confidence interval 0.79-0.91). The risk of death was lower in bisphosphonate users from day 6 of treatment, although the association was not significant until the second week. CONCLUSION: Bisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out.

Accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score and the Nottingham risk score in hip fracture patients in Sweden - A prospective observational study.

BACKGROUND: Little is known about accuracy of common risk prediction scores in elderly patients suffering from hip fractures. The objective of this study was to investigate accuracy of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, Portsmouth-POSSUM (P-POSSUM) score and the Nottingham Hip Fracture Score (NHFS) for prediction of mortality and morbidity in this patient group. METHODS: This was a prospective single centre observational study on 997 patients suffering out-of-hospital cervical, trochanteric or subtrochanteric fracture of the neck of the femur. Calibration and discrimination was assessed by calculating the ratio of observed to expected events (O:E) and areas under receiver operating characteristics curves (ROC). RESULTS: The 30-day mortality was 6.2% and complications, as defined by POSSUM, occurred in 41% of the patients. Overall O:E ratios for POSSUM, P-POSSUM and NHFS scores for 30-day mortality were 0.90, 0.98, and 0.79 respectively. The models underestimated mortality in the lower risk bands and overestimated mortality in the higher risk bands. In contrast, POSSUM predicted morbidity well with O:E ratios close to unity in most risk bands. The areas under the ROC curves for the scoring systems was 0.60-0.67. CONCLUSION: The POSSUM score and NHFS show moderate calibration and poor discrimination in this cohort. The results suggest that mortality and morbidity in hip fracture patients are largely dependent on factors that are not included in these scores.

Promising non-pharmacological therapies in PD: Targeting late stage disease and the role of computer based cognitive training.

Non-pharmacological interventions are increasingly being acknowledged as valuable treatment options to overcome or reduce functional problems in patients with Parkinson's disease (PD). There is a wide range of such non-pharmacological treatments for which the supportive evidence is emerging. Physiotherapy is one good example in this domain. However, there are also several promising non-pharmacological treatment strategies that have thus far received less research attention. Here, we describe two relatively new, but encouraging approaches. First, we focus on a hitherto largely overseen subgroup of PD, namely those with late-stage disease, a population that is often excluded from clinical studies. Importantly, the aims and therapeutic strategies in late-stage PD differ considerably from those in early-stage PD, and an emphasis on non-pharmacological management is particularly important for this vulnerable subgroup. Second, we focus on computer-based cognitive training, as an example of a relatively new intervention that includes innovative elements such as personalized training, artificial intelligence, and virtual reality. We review the latest evidence, practical considerations and future research perspectives, both for non-pharmacological approaches in late-stage PD and for computer-based cognitive training.

The International Collaboration of Orthopaedic Nursing: advancing nursing through technology.

AIM: To report on the International Collaboration of Orthopaedic Nursing, a mostly virtual network of orthopaedic nursing organizations across four continents. BACKGROUND: Formed by leaders of three national associations, the collaboration is based on recognition of patient problems and challenges shared by orthopaedic nurses globally. METHODS/INITIATIVES: The Collaboration provides a range of services including education, mentoring, and organizational development. Low cost internet-based technologies, such as email and Skype, support global networking in real time. DISCUSSION/IMPLICATIONS FOR NURSING AND HEALTH POLICY: The Collaboration is a cost effective example of how nurses can collaborate internationally to promote the highest standards of orthopaedic nursing.

Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.

BACKGROUND: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. METHODS: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (> or = 65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. RESULTS: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had > 4 prescribed drugs at admission and scored less well in the SPMSQ test. CONCLUSION: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.

Essential role of glucose transporter GLUT3 for post-implantation embryonic development.

Deletion of glucose transporter gene Slc2a3 (GLUT3) has previously been reported to result in embryonic lethality. Here, we define the exact time point of growth arrest and subsequent death of the embryo. Slc2a3(-/-) morulae and blastocysts developed normally, implanted in vivo, and formed egg-cylinder-stage embryos that appeared normal until day 6.0. At day 6.5, apoptosis was detected in the ectodermal cells of Slc2a3(-/-) embryos resulting in severe disorganization and growth retardation at day 7.5 and complete loss of embryos at day 12.5. GLUT3 was detected in placental cone, in the visceral ectoderm and in the mesoderm of 7.5-day-old wild-type embryos. Our data indicate that GLUT3 is essential for the development of early post-implanted embryos.

Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly.

PURPOSE: To evaluate the influence of background factors on the rehabilitation pattern after a hip fracture in the elderly. METHOD: Prospective registration based on the Swedish national register for hip fracture patients called RIKSHOFT/SAHFE (Standardised Audit of Hip Fractures in Europe). The place of living was registered both before fracture and during the following four months period (120 days). Graphs were calculated and drawn based on day-to-day changes. Also influences of age, sex, fracture type and type of operation were analyzed. RESULTS: The patient's pre-fracture functional capacity as evidence by the place they were able to manage to live before the fracture was the most discriminating factor for the rehabilitation; more than sex, fracture type or type of operation. Age was also a highly discriminating factor with a pronounced influence on the rehabilitation pattern. CONCLUSIONS: These background parameters are very important factors when planning the rehabilitation of hip fracture patients. A strategy with individualized planning of the rehabilitation procedure will be highly necessary in the future, in view of the increasing amount of elderly with hip fractures prognosticated during the coming decades. The knowledge about influencing factors here presented will be useful when planning and performing the rehabilitation for this resource-consuming group of patients.

[The Leipzig University Gynecologic Clinic (Trier Institute) from its establishment in 1810 to 1945]. / Die Universitätsfrauenklinik Leipzig (Triersches Institut) von den Anfängen im Jahre 1810 bis 1945.

At the beginning of the 19th century the childless couple Trier gave a plot of land to Leipzig University with the impost of founding a maternity hospital (Accoucheur Institute) and demand to take their family name as clinic name. The institute was erected in 1810 and later (1892) extended as a department of obstetrics and gynecology. The Women's Clinic of the University ("Triersches Institut") developed very favorably through the 19. and 20. century, including the difficult time of national socialism and the years after World War II. This is documented by it's expansion with several enlargements and new buildings. The institution acquired a remarkable national and international reputation due to prominent scientific and clinical results of the famous professors working at the place such as Jörg, Credé, Zweifel, Stoeckel, Sellheim and Robert Schroeder.

[Some aspects of the life work of Ludwig Fraenkel (1870-1951) with special reference to his social gynecology and sexology studies]. / Zu einigen Aspekten des Lebenswerkes von Ludwig Fraenkel (1870-1951) unter besonderer Berücksichtigung seiner sozialgynäkologischen und sexualwissenschaftlichen Arbeiten.

The gynaecologist Ludwig Fraenkel is known because of his works concerning the endocrine function of the corpus luteum. Moreover he was an important representative of the social gynaecology and sexology during the first decades of this century. His studies in these fields identify Fraenkel as an independent scientist considering for example social living conditions as a cause of gynaecological illnesses. On the other hand he took over problematic positions in eugenics hoping to improve public health. During the Hitler era the Jew Ludwig Fraenkel was dismissed from the directorate of the Women's clinic of the University of Breslau. He left Germany forever.

[Hugo Sellheim (1871-1936): Leipzig acknowledgement of gynecology]. / Hugo Sellheim (1871-1936): Leipziger Bekenntnis zur Frauenheilkunde.

In 1928 Hugo Sellheim, Professor and Chairman of gynaecology and obstetrics at the University of Leipzig (1926-1936), inaugurated the new Clinic of Gynaecology and Obstetrics. The opening ceremony found a critical public response. Although the new building had been drawn up by his predecessor Walter Stoeckel, Sellheim developed own ideas concerning the equipment of the institution. In Leipzig Sellheim is continued his scientific efforts with a story focus on female reproduction and its sociocultural impact during the period of the Weimar Republic.

Maternal floor infarction in autoimmune disease: two cases.

Two cases of maternal floor infarction in women with autoimmune antibody production to various antigens are presented. We speculate that maternal floor infarction could be produced by antibodies directed against the placental urokinase plasmin system.

[Informal care; a critical observation]. / Informele zorg; een kritische reflectie.

In this article the policy aimed at cutting down expenses for professional care and at optimizing the contribution of informal, unpaid care (e.g. family caregivers and volunteers) is questioned. After a brief outline of the non-professional care system for the elderly, some problematic aspects of informal care are discussed, especially the influence of such care in terms of (over)burden, the quality of care and the consequences for the relationship between caregiver and person being cared for. Voluntary services are also questioned, particularly the lack of control, the power of volunteers and their knowledge, attitude and skills. It is concluded that expectations towards nonprofessional caregivers should not be too great. The importance of a finely tuned coordination and clear division of tasks in the care network is underlined. Finally a number of recommendations is made to settle the observed bottlenecks.